Anaesthesia Concern in High-Risk Cases Under-Going Ambulatory Laparoscopic Cholecystectomy

Abstract

Objective: To evaluate pre-operative implications, anesthetic management and post-operative anesthetic concerns in patients with co-morbid diseases undergoing ambulatory laparoscopic cholecystectomy under general anesthesia. Study Design and setting: Retrospective study was conducted at Rawal Institute of Health Sciences, Islamabad from 8th Oct 2017 to 5th Nov 2018. Methodology: Total one hundred and twelve patients were placed in American society of Anaesthesiologist (ASA) class II, III & IV (medically optimized) on pre-operative evaluation for ambulatory laparoscopic cholecystectomy. General anesthesia was administered with co-induction (nalbuphine 0.1mg/kg plus midazolam 0.01mg/kg) tracheal intubation facilitated by 0.15mg/kg cis-atracurium. Post-operatively on clinical status evaluation and Post Anesthesia Discharge score, patients were shifted to respective ward /intensive care. Statistical analysis was done by SPSS v.21. Results: Pre-operatively medical and cardiologist evaluation was taken in 34(30.35%) and 42(37.5%) cases respectively whereas consultant anesthesiologist reviewed all cases. In study single case was converted to open method due to mirrizi syndrome and adhesions creating difficult laparoscopic dissection in 9(8.03%) of cases. Post-operatively in single case atrial fibrillation with fast ventricular response noted followed by sudden bradycardia, managed and sinus rhythm restored, whereas in other case of ischemic heart disease with viral respiratory infection, needed ventilatory support after 2 hours due to respiratory distress and weaned off after 24hrs. In the study 76(67.9%) cases were shifted post-operatively to surgical ward and 36 cases (32.1%) needed intensive care treatment. Conclusion: Laparoscopic cholecystectomy in patients with co-morbid states requires balanced anesthetic technique considering consequences of pneumoperitoneum to decrease morbidity.